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The Rise of the Trauma State: Afghanistan and America’s Unwinnable War

Post-traumatic stress disorder afflicts 11 to 20 percent of U.S. military members after
they serve in Afghanistan or Iraq. The military expends significant
effort to provide them with needed care. Commanders move the
psychologically injured out of the combat zone. Medical and mental
health providers deliver needed aid. And, commanders may
temporarily suspend individuals’ authority to bear firearms
to minimize any threat they pose to themselves or others. For good
reason: studies indicate that combat veteran status and
PTSD associate with a two to three times increase in the risk of violence against others.

If trauma has such negative effects on U.S. service members
despite all of the assistance available, what are its effects on
Afghans who have lived in a combat zone for 40 years straight with
little access to care? More importantly for the United States, how
does all of that trauma and PTSD affect America’s longest
war? I argue that Afghanistan’s national trauma assures U.S.
policy goals will continue to go unmet and, as a result, U.S.
forces should be withdrawn.

When at war, the U.S. military prioritizes winning, not mental
health. Grievous psychological harm has remained the concern of
helping agencies and religious organizations. Warfighters rightly
eschewed such issues in order to focus on killing enemy forces and
destroying their warfighting capability. But this war is different.
It is as much (or more) about the villagers caught in the middle
and their government as it is about the insurgents. General
Petraeus observed that “the human terrain is the decisive
terrain.” For this type of war, doctrine calls on military
members to have “an adaptive and flexible mindset to understand the population,” in contrast to the
traditional enemy-centric focus. However, despite the U.S.
military’s attempts to learn the languages, religion, and
culture, the decades of psychological trauma experienced by Afghans
have gone unexamined.

The scope and scale of trauma endured by Afghans is staggering.
Upwards of 50 percent likely met the criteria for PTSD, major
depressive disorder, or both before the U.S. invaded in
2001. A meta-analysis of conflict-affected populationspublished in the
Journal of the American Medical Association calculated
that half of a population exposed to extremely high rates of
torture and political terror will meet the criteria for one or more
mental disorders. Afghanistan has met those criteria for
decades.

America has no good
choices in Afghanistan. The least bad option, though, is likely the
withdrawal of U.S. forces.

Severe and repetitive trauma over four decades has had at least
three major consequences for Afghans. Violence has become
normalized as a legitimate means for goal achievement and problem
resolution. The people lack the capacity for trust required for an
enduring settlement across dissimilar ethnic and religious groups.
And, Afghans do not have the ability to govern effectively,
especially problematic for a nascent democracy.

Hurt People Hurt People

Trauma states like Afghanistan become more violent as a result
of all the trauma and negative effects which often accompany it.
Increased exposure to severe traumatic stressors, such as torture,
rape, and war, results in more mental
illness, substance abuse, and diminished impulse
control. Taken together, those three factors dramatically increase
violence rates.

Larry Goodson observes that killing has become “a way of
life in Afghanistan, creating “a cult of violence.” Others have
expounded on the role of psychological factors on violence,
observing that previous trauma negatively alters violence
norms. Explaining societal violence after civil conflict has
ended, Chrissie Steenkamp refers to a “culture of violence” in which “the
norms and values that underpin the sustained use of violence”
become established in the society.

A scene during my deployment to Afghanistan in 2010 (and right
out of Dr. Strangelove) makes the point. An argument took place in
the “war room” between two Afghan colonels. The senior
police official drew his pistol to shoot a peer from the security
directorate over an insult. An American military officer—and
friend—bravely placed himself between the gun and intended
target and spoke the only English the middle-aged police chief
understood, “It’s okay. It’s okay.” With
the situation peacefully resolved, they banned the police leader
from the operations center for 30 days and all government buildings
posted makeshift signs indicating no guns allowed.

The police chief serves as an archetype of the traumatized
Afghan. A brave fighter against the insurgents, he has been at war
for all of his adult life and has become a drug addict in response.
Self-medication was preferable to no medication, and soberly
confronting his demons was too painful. The Colonel’s impulse
control had plummeted well below safe levels. Violence has become
his reflexive tool for goal achievement and problem resolution.

Eroding Trust

Repeated exposure to traumatic events severely erodes a
person’s ability to trust. Additionally, victims of
repeated traumas often develop attentional bias towards expressions
of anger and fear and they tend to miss cues associated
with happiness, amplifying the cycle of distrust. The effects appear particularly pronounced when the
traumas occur early in life. The fact that Afghans have suffered so
much trauma at the hands of so many different actors intensifies
the erosion of trust.

Diminished Capacity, Diminished Governance

Adverse changes to the brain can also follow severe and repeated trauma.
These alterations include reduced hippocampal volume
and hemispheric integration, decreases in corpus callosum size, and
diminished activity in the basal ganglia. These changes associate
with a variety of negative outcomes, including lowered intelligence
quotient, diminished capacity to reason, and poor problem-solving
skills.

Everyone, government officials included, becomes less competent.
Governance and the delivery of basic goods and services suffer.
This is particularly problematic in a democracy, where government
legitimacy derives from its competence.

Militaries Can’t Fix Trauma States

Afghanistan’s national trauma helps explain why nation
building efforts have been so difficult and the gains from American
combat power so temporary. Only Afghans can bring about enduring
change, and they are too traumatized to do it. The trauma-induced
“cult of violence” fuels the war, eroding the
possibility for negotiation. Politicians cannot trust each other,
which further incentivizes the use of violence rather than dialogue
for goal achievement. The cognitive deficits resulting from decades
of trauma reduce the capacity of government bureaucrats and
security forces, adding to the population’s grievances. And
because the trauma is on-going—civilian deaths are at record highs—and
Afghans have meager mental health infrastructure, these problems
should only get worse.

Implications for U.S. Policy

America has no good choices in Afghanistan. The least bad
option, though, is likely the withdrawal of U.S. forces. Sixteen
years of fighting later and the Afghan government remains egregiously corrupt and incompetent, while the
Taliban now control more territory than at any
time since 2001. Traumatized Afghans have a lot to do with it, and
American combat power has no answer for that.